UK Health Service: Children Questioning Their Birth Gender ‘May Be a Transient Phase’

Patrick Goodenough | October 26, 2022 | 4:45am EDT
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A protest sign outside the Gender Identity Development Service (GIDS) in London, England. The NHS is closing the clinic after a critical independent review. (Photo by Guy Smallman / Getty Images)
A protest sign outside the Gender Identity Development Service (GIDS) in London, England. The NHS is closing the clinic after a critical independent review. (Photo by Guy Smallman / Getty Images)

( – Newly drafted National Health Service (NHS) guidelines for dealing with minors in the U.K. questioning their birth gender say doctors should be “mindful that this may be a transient phase,” and that a “process of watchful waiting” may be appropriate.

They also recommend that doctors adopt an approach reflecting evidence that “in most pre-pubertal children, gender incongruence does not persist into adolescence.”

Moreover, the guidelines warn that when pre-pubescent children want to undergo “social transition” – that is, changing names, pronouns, dress, hairstyles etc. – doctors should be aware of the difficulties they may experience if later wanting to revert to birth gender roles.

“[T]he clinical approach has to be mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty if the gender incongruence does not persist into adolescence.”

The NHS in England is revamping the way it deals with gender-questioning under-18 children and teens, after a series of controversies surrounding the London-based Gender Identity Development Service (GIDS), the world’s largest clinic of its kind.

The London Times reported in August that around 1,000 families may join a class-action medical negligence lawsuit against GIDS “alleging vulnerable children have been misdiagnosed and placed on a damaging medical pathway.”

The NHS is closing the London clinic, replacing it with regional centers based at hospitals specializing in children’s care.

Two years ago the country’s taxpayer-funded health service commissioned a review into gender identity services for minors, chaired by Hilary Cass, a leading pediatrician.

The draft guidelines, based on Cass’s recommendations, say that “social transition” such as changing pronouns and attire should not be viewed as “a neutral act” but rather as active intervention, “because it may have significant effects on the child or young person in terms of their psychological functioning.”

In the case of teenagers, the guidelines say “social transition should only be considered where the approach is necessary for the alleviation of, or prevention of, clinically significant distress or significant impairment in social functioning.”

It should also only be considered if the adolescent has been diagnosed with “consistent and persistent” gender dysphoria; has expressed a clear wish, and fully understands the implications of the actions; and once associated needs and risks have been addressed.

NHS England reported a surge in children and teenagers referred to GIDS in recent years. While in 2022-2012 there were just under 250 referrals, in 2021-2022 there have been more than 5,000, it said.

It also reported that where once it was mostly young boys (“birth-registered males”) who were seeking help, there had been a “dramatic change,” and most of those being referred now are girls (“birth-registered females”) in their early teens.

In other recommendations made by Cass,

--Clinical teams dealing with referrals should be broadened beyond “gender dysphoria specialists,” to include experts in pediatric medicine, autism, and mental health. (“A significant proportion of children and young people who are concerned about or distressed by issues of gender incongruence, experience co-existing mental health, neuro-developmental and/or family or social complexities in their lives.”)

--A medical doctor should lead the team providing the service.

--Whereas up to now some referrals have been made by health and social services staff, schools, or voluntary organizations, from now on they should be made only by doctors and NHS professionals.

The guidelines also warn about the availability of “masculinizing” and “feminizing” hormone treatments and puberty blockers from unregulated providers, often online.

It says in such cases the service should alert the child and family to the risks, including “any irreversible or partly reversible effects of the drugs,” and initiate “local safeguarding protocols” – which in NHS terminology usually means informing the police and relevant social services.

The guidelines are open for public consultation from Oct. 20 until Dec. 4.

‘Gender-affirming health care’

During an interview with the news site Now This News, broadcast on Sunday, President Biden was asked by transgender “TikTok influencer” Dylan Mulvaney whether he thinks “states should have a right to ban gender-affirming health care.”

“I don’t think any state or anybody should have the right to do that, as a moral question and a legal question,” Biden replied. “I just think it’s wrong.”

“Sometimes they try to block you from being able to access certain medicines, being able to access certain procedures, and so on,” Biden said. “None of that should be available – I mean, you know, no – no state should be able to do that, in my view.”

“So I feel very, very strongly that you should have every single solitary right, including – including use of your gender-identity bathrooms,” he said.

Biden added that it was important to “continue to speak out about the basic fundamental rights of all human beings,” adding that what was happening in some states is “outrageous – and I think it’s immoral.”

“The ‘trans’ part’s not immoral,” he clarified. “What they’re trying to do to trans persons is immoral.”

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